Machine Translated by Google

State of Kuwait
Ministry of Health
Infection Control Directorate

Guidelines for Design of

Operating Theaters

2007
Machine Translated by Google

CONTENTS

Page
Introduction ………………………………………………………………… 4
Lay out of the operating theater ……………………………………………
Zones of the Operating Theater …………………………………………… 44

The dirty outer zone ……………………………………………………… 5

Main Access corridor, reception and waiting area ……………………. 5

Staff clothing change areas ………………………………………….... 5

Dirty utility room or soiled work room (sluice) ……………………… 6

Janitor area (housekeeping) ……………………………………………

The clean zone ……………………………………………………………..
6 6 The sterile supplies store ……………………………………………… 7 General
Purpose Store …………………………………………………. 7 Medication station
……………………………………………………… 7 Anesthesia room
………………………………………………………… 7
Sub-sterile area ………………………………………………………….. 8 Recovery
Area ………………………………………………… ………… 8 Scrubbing area
…………………………………………………………… 8 Scrub sinks
…………………………………………… ………………… 9 Clean work room
(Clean utility room) …………………………………. 9 Rest area, lounge for staff,
report preparation area, and toilet facilities. 9 A supervisor's offices or stations
and teaching areas ………………… 9 Other Service Areas
………..…………………….……………………… 10 Sterile Core …………
……………………………………………………….. 10 10 11 Specific requirements
Measurements ……………………………………………………………
General issues ……………………………………………………………
……………………………………………….. 12 Walls
……………………………………………………………………... 12 Floors
………………………………………………… ………………….. 12 Ceiling
……………………………………………………………………. 13 13 Doors
………………………………………………………………………
Illumination ………………………………………………………………. 13 Operating
room lights …………………………………………………… 14 Recommended
illumination levels in each room ………………………. 15 Air supply
………………………………………………………………… 16 Plenum Ventilation
………………………………………………… …… 16 Laminar flow ventilation
………………………………………………… 16 Recommended specifications of Air
Supply in different areas of the OT 17

2
Machine Translated by Google

Temperature and humidity ……………………………………………… 18

Scavenging system ……………………………………………………. 18 Gas and
suction system ………………………………………………. 19 Water supply
…………………………………………………………. 19 Drainage system
…………………………………………………….... 20 Communication
……………………………………………………… … 20 Electricity
……………………………………………………………… 20

Safety requirements ………………………………………………….. 21 Fire Alarm 21 Portable

Fire Extinguishers
………………………………………………………………
……………………………………………. 21 Emergency
. lighting
……………………………………………………… 22 Exit signs
…………………………………………………………… …… 22 Emergency exit
doors …………………………………………………… 22

References ……………………………………………………………………….. 23

3
Machine Translated by Google

Introduction

In the past few years there has been an effort to renovate and build new specialty centers throughout
Kuwait. Many of them involve the renovation and expansion of many operating theaters with the
addition of new specialties which have created the necessity of national guidelines to build and renovate
such facilities.
The number of operating rooms and recovery beds and the sizes of the service areas shall be based
on the expected surgical load. In the program, the size, location, and configuration of the surgical suit
and support service departments shall reflect the projected volume of outpatient. This may be achieved
by designing either an outpatient surgical facility, or a combined inpatient-outpatient surgical suit.

This design of a standard operating theater would include a reception area, a recovery bay for post
operative patients and operating theater suites (according to the needs of the center) with provisions
for endoscopy or plaster rooms or other special rooms required.
Facilities include individual theater storage and adequate areas for storing portable equipment such as
X-ray machines, and stocks of disposable and sterile goods, offices, staff rest areas, changing rooms,
seminar facilities, janitory room, dirty room and clean room.

Lay out of the operating theater

Important design considerations include the mix of inpatient and surgical operations, patient flow, into
and out of the operating room (OR) area, the transportation of supplies and waste materials to and
from the OR, and flexibility to allow the incorporation of new technologies.
The operating theater should be zoned into aseptic and clean areas in addition to being separated from
the outer areas (Table 1). This is to restrict access and maintain unidirectional movement.
An operating room suit design with a sterile core must provide for no cross traffic of staff and supplies
from the decontaminated or soiled areas to the sterile or clean areas.

Table (1): Zones of the Operating Theater.

Zone Barrier Areas included

Dirty outer zone Physical Sluice, storage, waste disposal, outside corridor, changing rooms
Clean Partial Supply store, disinfection room, anesthetic room, recovery room.
Sterile core Physical Operating Room, sterile preparation.

The use of facilities outside the operating room for soiled / decontaminated processing, clean assembly
or sterile processing shall be designed to move the flow of goods and personnel from clean/sterile to
dirty without compromising universal precautions or aseptic techniques in both departments.

4
Machine Translated by Google

1. The dirty and outer zone:

This should contain:

• Main access corridor, reception and waiting area.
• An entrance to the changing facilities. •
Accessible area for the removal of waste(janitor area) • Dirty
utility room or soiled work room (sluice)

Main Access corridor, reception and waiting area:

- The entrance to the access corridor shall be electronically controlled allowing only authorized
personnel access to the area (code operated or magnetic card).
- The reception area shall be a minimum of 52 square meters.
- Cultural issues should be taken into consideration such as separation of the male and
female patient in reception areas.
- This area includes the checking of preoperative patients and a waiting area, divided by curtains to
provide privacy for the individual patient. Each trolley space shall be serviced with oxygen and
suctioning, preferred in wall panels.
- Twelve bed or trolley spaces shall be catered for an 8 theater department, the general rule being
1.5 bed spaces per theater, with the space allowed for the trolley or stretcher shall be a minimum
of 2.1 x 1.6 meters with minimum clearance 1.2 meter on the sides of the trolley or stretcher.

- The transfer area shall be a minimum of 22 square meters.

- Provisions shall be made for the isolation of patients with infectious diseases.
- A control station should be located to permit visual observation by the nursing staff
for all traffic in and out of the suit.

Staff clothing change areas:

- Appropriate areas shall be provided for male and female personnel (cleaners, technicians, nurses,
and doctors) working within the surgical suit.
- The areas shall contain lockers, showers, toilets, lavatories equipped for hand washing, and space
for donning surgical attire.
- Showers are not recommended prior to start of the duty, however they are allowed
after duty hours.
- These areas shall be arranged to encourage a one way traffic pattern so that personnel entering from
outside the surgical suit can change and move directly into the surgical suit.

5
Machine Translated by Google

Dirty utility room or soiled work room (sluice):

- There shall be room to wash down trolleys, containers for dirty linen, rubbish and dirty
instrument.
- The soiled workroom shall contain a flushing rim, drainer, a slop hopper or other provisions for
disposal of liquid waste.
- The room shall not have direct connection with operating rooms or other sterile
activity rooms.
- The soiled workroom shall contain a hand washing station, with hot and cold mixing
faucet.
- The room shall have a work counter and space to separate covered containers for soiled
linen and waste.

Janitor area (housekeeping):

- House keeping facilities shall be provided for the exclusive use of the surgical suit
- It shall be directly accessible for the suit, shall contain hand washing station, and provision for
storage of supplies and house keeping equipment.
- This room shall be separate from the clean workroom.

2. The clean zone:

This contains:
• The sterile supplies store. •
General purpose Storage area ( for storage of stretchers, wheelchairs, patient transfer and carrying
devices, etc.) • Medication
station. • Anesthesia
room. • Sub-sterile area

• Recovery area. •
Scrubbing area. • A
clean hallway
• Clean utility room. •
Rest area and lounge for staff.

6
Machine Translated by Google

The sterile supplies store:

- Sterile supplies store: storage space for sterile and clean supplies should be adequate for the
functional plan. The space should be moisture and temperature controlled and free from cross
traffic.

General Purpose Store:

- Equipment storage room( for equipment and supplies ): each surgical suit shall provide sufficient
storage area to keep its corridor width free of equipment and supplies but not less than a total
of 13.9 square meters or 4.65 square meters per operating room, which ever is greater.
greater.
- Storage areas for portable X-ray equipment, stretchers, fracture tables, warming devices
auxiliary lamps etc. these areas shall be out of corridors and traffic.

Medication station:

- Provisions shall be made for storage and distribution of the drugs and routine
medications used in the theater. This can be done from a medicine preparation room or unit.

- If used, a medicine preparation room or unit shall be under visual control of the
nursing staff.
- It shall contain a work counter, sink, refrigerator and double locked storage for controlled
substances.
- Hand washing station shall be provided.

Anesthesia room:

- There shall be built in cupboards and work benches, with a fitted stainless steel sink and drains.
Racks that are enclosed in cupboards with glass panels shall be provided for anesthetic tubing
and storage for equipment.
- Safety drug cupboards shall be installed and service panels fitted to the wall.
- All surfaces shall be hard wearing and washable. Wood must not be used.
- Free standing equipment shall include anesthetic machine, monitor, and defibrillator.
- The anesthesia work room for cleaning, testing, and storing anesthesia equipment shall
contain work counters, sinks, and racks for cylinders.
- Provisions shall be made for separate storage of clean and soiled items.
- In new construction, depending on the function and programs, the anesthesia work room should
provide space for anesthesia case carts, and other anesthesia equipments.
- The room shall be a minimum of 12 - 16 square meter

7
Machine Translated by Google

Sub-sterile area:

It acts as a service area between 2 or more operating or procedure rooms and should be equipped with flash sterilizer
(for immediate or emergency use only), warming cabinet, sterile supply storage area and hand washing station.

Recovery Area:

- Recovery area shall be a minimum of 110 square meters - This

area works on 1.5-2 beds per theater and includes nursing stations, and clean utility area of 10 square
meters and a dirty utility room of 10 square meters.
- Each bed or recovery space shall be 2.40 square meters.
- Each bed space shall be cubical with curtains and shall have service pendants or walls
panels at the head of each bed.
- Services shall include suction, oxygen, air and electricity points.
- A monitor shall be available for each bed and access to defibrillators and respirators.
- There shall be hand washing basin between two trolleys - There
shall be an examination light over each bed space.
- There shall be two sets of exit doors, one set leaving to the main hospital wards, and
the other set directly into the intensive care unit.
- The connecting door to the intensive care unit should be through the clean corridor, passing through a
changing room where personnel are required to change into clean surgical attire before entering
the operating theater

Scrubbing area:

- Scrub room shall be approximately 9.25 square meters. Facilities must include a scrub sink for at
least 3 people, with hands free operable controls. There shall be a glove and gown bench or trolley
separated from the sink.
- Scrub position shall be provided near the entrance to each operating room.
- Scrub facilities should be arranged to minimize incidental splatter on near by personnel,
medical equipment or supply carts.
- View windows at scrub stations requires observation of room interiors should be
provided. provided.

8
Machine Translated by Google

Scrub sinks:

- Scrub sink used for surgical scrubbing must be of cleanable and disinfectable material
such as stainless steel.
- The sink should have rounded corners to allow easy cleaning and prevent
accumulation of water and bacteria.
- Hands free operation is a must, for example elbow operated or electronic sensors.
- High side panels to control splash are preferred.
- The water source should be at high enough level not to come in contact with the
scrubbing person's arm during the procedure of scrubbing and not far from the edge so that the
scrubbing person does not lean on the edge of the sink and contaminate his clothing.

- Knee operated sinks are not preferred because of the contact with the surgeon's
clothing. clothing.

- Surgical scrub solution shall be dispensed with hands free apparatus.

- Scrubbing up room shall have a clearly identified timer or clock for timing of the scrubbing
procedure. This may also be an electronic timer.
- Course filters shall be installed to filter the water used in scrubbing room

Clean work room (Clean utility room):

- This room should not be used for food preparation

- A clean work room is required when clean materials are assembled within the surgery
suit prior to use
- It shall contain a work counter, a hand washing station and storage facilities for clean supplies

Rest area , lounge for staff, report preparation area, and toilet facilities:

- Separate or combined lounge for male and female staff shall be provided. Lounge shall be designed
to minimize the need to leave the suit and to provide convenient access to the recovery room.

- These lounges may contain furniture for rest, area for food and drinks preparation, TV,
computer, fridge and toilet with hand washing facilities.
- The furniture should be easily washable and non dust forming or collecting. Wooden
furniture is not allowed inside the theater suit.
- Report preparation area shall be provided and shall be accessible from the lounge area.
- A supervisor's offices or stations and teaching areas: the number of these offices
depends on the functional program of the operative suite.

9
Machine Translated by Google

Other Service Areas:

- Medical gas storage facilities should provide additional separate storage of reserve
gas cylinders necessary to complete at least one day procedures and must comply with rules of national
fire authority
- Area for preparation and examination of frozen sections, it may be a part of
general laboratory if immediate results are obtainable without unnecessary delay in completion of
surgery - Area for
refrigerated blood bank storage that meet standards of blood banking - Area for refrigeration
facilities for harvested organs - Area for pathology specimens
storage prior transport - Ice machine should be provided from self
dispensing ice makers to provide ice for treatment and patient use.

3. Sterile Core:

- The restricted area of the operating suit includes: operating and procedure rooms - In this area
surgical attire and hair coverings are required.
- Masks are required where open sterile supplies or scrubbed persons may be located - Signs shall
clearly indicate the surgical attire required in each area.

Measurements:

- The operating theater should be a quadrangular room with a minimum clear area of 36 square meters, 6
x 6 meters, exclusive of fixed or wall mounted cabinets and built in shelves, with a minimum 6meters
clear dimension between fixed cabinet and built in shelves and a system for emergency communication
with the surgical suit control station. Ceiling height should be a minimum of 3.2 meters. In addition
1-2 feet of ceiling height may be needed if radiology equipment is to be permanently mounted.

- Theater may be larger depending on the requirements; rooms for cardiovascular, cardiovascular
orthopedic, neurological and other special procedures that require additional personnel and/or large
equipment, when included this room shall have in addition to the above a minimum clear are of 56
square meters with a minimum of 6 meter clear dimension exclusive of fixed or wall mounted cabinets
and built in shelves.
- When open heart surgery is performed an additional room in the restricted area of the surgical suit
preferably adjoining this operating room shall be designated as a pump room where extracorporeal
pumps, supplies and accessories are stored and serviced.
- When complex orthopedic and neurosurgical surgeries are performed, additional room shall be in the
restricted area of the surgical suit. Preferably adjoining the specialty operating room which shall be
designated as equipment storage room for the large equipment used to support these procedures.

- Endoscopy theaters and plaster rooms may be smaller than the standard size. There shall be provision for
an operating table, shadowless theater light surface pendants, panels and at least 4 fitted X-ray film
illuminators. There shall be room for the various pieces of mobile equipment required such as trolleys,
swab racks, and kick buckets, and machinery such as diathermy, ECG monitors, defibrillators,
and mobile X-ray machines

ten
Machine Translated by Google

- Provision shall be made for appropriate clear space, mechanical facilities and electrical connections
to accommodate the special functions of the above mentioned rooms.

General issues:

- Glass fronted cupboards for storing various small items required during surgery for example,
needles and dressing tapes, shall be built into the walls. This prevents dust collecting on top
of cupboards which are wall mounted. Non glare, see through glass doors of cupboards shall be
trimmed with stainless steel wall when closed. There , which makes the door lie flush with the
shall be a minimum of joints in the frame and the cupboard shall be designed to ensure adequate
cleaning.
- All storage shall be at a height which is easily accessible.
- X-ray screens and service pendants shall be built into the wall so that they are flush, to insure ease
and efficiency of cleaning and minimize the risk of dust collection and infection.

- There shall be provision for two X-ray electrical sockets and 6 twin electrical outlets in
addition to service pendants and service wall panels
- Windows must not be built in the sterile area but only in the dirty zone and should
contain a filter for not allowing insects inside the theater It is
- advised to consider future medical advances when designing an operating theater although it is
considered less cumbersome to have equipment built into the walls, to lessen the problem of dust
collection and infection, items such as monitors should be free standing, as development in
their efficiency may make them smaller and more compact.

11
Machine Translated by Google

Specific requirements

Walls:

- Walls are to be painted with seamless coating material which is bacteriostatic and can
tolerate washing with detergents and disinfectants without deterioration of surface
bonding ( Apoxy - acrylic resin )
- Walls in operative rooms (instead of painting) could be covered with full height
1.5 mm thick flexible vinyl sheeting welded to antistatic floor with round skirting level

- Walls in anesthesia, scrubbing and recovery rooms (instead of painting) may be

coated with flexible vinyl up to the level of 1.2 meters.
- Walls must be smooth without cracks, seams, open joints, crevices or dividers which
harbor dust, insects or bacteria and all cut edges should be tapered to the wall to
prevent collection of dust
- Walls must be scratch resistant , with standing wear and tear with fixed smooth trolley
height wall protectors along corridors and exit areas -
Wall surfaces should be hard and resist impact, impermeable , stain proof and easy to
clean
- Around sinks and washbasins there should be ceramic tile splash back adequately
bonded with smooth water proof type of grout
- Walls penetrated by pipes, ducts and conduits should be tightly sealed to minimize
entry of insects and rodents

Floors:

- Throughout the operating theater suite (the theater, anesthesia room, scrubbing-up
room and recovery room). The flooring should be 2-5 mm thick flexible, antistatic
vinyl sheet. Welded at the seems, to provide a safe continuous water proof surface.
- The antistatic vinyl sheeting should be coved up the wall, to form a 100-150 mm
skirting.
- All corners shall be slightly rounded to prevent the harboring of dust and bacteria, and
there shall be no cracks or cervices at the seams or at the walls, which may allow pests
such as ants and cockroaches into these clean areas.

twelfth
Machine Translated by Google

Ceiling:

- Ceiling shall be smooth, nonporous, scrubbable, non-perforated, without cervices or seams and
capable of withstanding harsh chemicals - Ceiling shall
be easily cleanable, non-friable and monolithic.
- Cracks or perforations in these ceilings are not allowed.
- The minimum ceiling height shall be 2.4 meters, with the following exceptions:
1-Ceiling in operating, delivery rooms and other rooms containing ceiling mounted surgical
light fixtures shall be of sufficient height to accommodate the equipments or fixtures and
their normal movement (see measurements for OR, page 10)
2- Ceiling in corridors, storage rooms and toilet rooms shall be not less than 2.35
meters. meters.

- Equipment rooms and similar spaces where impact noise may be generated shall not be
located directly over delivery and operating suit.

Doors:
- There shall be double doors from the anesthetic room into the theater, and from
the theater through the exit lobby, at least 1.5 meter in width - Other
doors to and from the dirty utility rooms and the scrub up room shall be a minimum of 1
meter in width.
- Doors should NOT be manufactured of wooden material.

- All doors shall have a small, high window and shall be electronically operated.
- Doors should be made of washable material which can tolerate washing with
detergents and disinfectants.

Illumination:

- Operating and delivery rooms shall have general lighting in addition to special lighting
units provided at surgical and obstetrical tables.
- General lighting and special lighting shall be on separate circuits.
- Lighting should be bright and evenly light spaces.
- Lamps should render natural colors.
- Lamp surfaces should be easy to clean and not collect dust.
- Fixtures should limit glare or any other undesirable reflections and direct view of
lamps.

13
Machine Translated by Google

Operating room lights:

- Optimal illumination in the surgical field is essential, especially during precise surgical procedures .A
wide range of surgical lights are available and should be closely matched to the needs
of the procedures to be performed. Specific considerations include the intensity of the
light, the size of the illuminated field, the production of heat and shadows, and the
maneuverability of the lamps.
- A common model consists of a single lamp placed in the center of a concave reflective shell, each
aligned at a slightly different angle to widen the illuminated area and minimize shadows.
The diameter, shape, and composition of the concave reflective surface determine the focus
depth, as well as the shadows and glare produced. Models equipped with focus adjustment to
help sharpen the intensity of the illumination are available.

- In addition to field size and illumination, maneuverability is a vital consideration.

Ceiling-mounted tract lighting provides the greatest range of motion, with as much as
360degrees flexibility and it fully illuminates the head and feet. Ceiling-mounted fixed units are
most commonly used. They should be situated over the table to illuminate the largest field
possible. All lights should be equipped with handles to allow the staff to position them during
the procedure. These handles should be capable of being sterilized. Disposable sterile
handle covers are available from most manufacturers.
- The range of movement over the operating table shall consist of a diameter of 3.5
meters, with the center of the table as the center of the circle. The normal height from the
ground shall be 2.06 meters, but shall also be capable of a height not less than 1.5 meters.
The light shall be capable of a 360 degree rotation .It shall be completely stable when positioned.

- The light shall have focus and dimming control, but it is preferable for the dimmer not
to be positioned on the light.
- It shall be possible for a failsafe mechanism to be incorporated into the theater light, so that if
one lamp fails then there is a second lamp which gives sufficient light to continue work.
This second lamp shall give a minimum of 50% intensity of the first lamp.

- A tungsten lamp of at least 24 volts is usual .The light shall not cause shadows and
shall be sufficient to see clearly into a deep wound. The intensity of the light shall be between
1000 and 3000 lumens/sq foot, according to the personal preference of the surgeon.

- The external surfaces of surgical luminaries shall be antistatic, and not attract dust particles.
The theater light and the fittings shall be capable of easy cleaning and maintenance.

- The luminaries shall not be capable of transmitting heat in a down ward direction,
which may dry the tissues in the wound and over heat the surgical team. Provision
shall be made for the heat generated by the lamps to be expelled over from the
center of the operating field.

14
Machine Translated by Google

Table (2): recommended illumination levels in each room

I luminance (Foot-candles)
Surgical suite
Operating room, general 150-200
Operating table Task lighting as required 75
Scrub general 50
Clean up room, instruments 30
Anesthesia storage 30
Sub-sterile room

Toilets/ bathing
General(Includes water closets , 30
shower/tub)
Night lighting 3
Utility room (clean and soiled )
General 30
Work counter 50
Stairways 20
Storage rooms 20

Obstetric delivery suite

Scrub , general 75
Operating room 150-200
Delivery table Task lighting as required 75
Post-delivery recovery area 30
Sub-sterilizing room 20
Janitor closet 20
Locker rooms

Corridors
Day 20
night 10

15
Machine Translated by Google

Air supply:

The air supply to each operating theater suit should be independent, so that it can be switched off and
maintained without affecting the entire theater complex. If this is not feasible, each unit should provide no
more than two separate suits.

Types of air supply:

Air is supplied to the operating theater by:
1- Plenum Ventilation (conventional):
This is the most frequently used system in general purpose operating rooms.

2- Laminar flow ventilation:

The laminar flow is used in specialized orthopedic units and cardiothoracic units, often in conjunction
with sophisticated closed. This system is unidirectional and delivers air flows over the operating table
of 300 air changes per hour and a bacterial count of 10 (BCP) or less per cubic meter at wound site.
Laminar flow may be delivered vertically or horizontally; the former is preferable.

Design features :

• Air changes
- Maintenance of 20 -24 changes per hour, of which at least 5 should be fresh air
from outside. Approximately 80% of the air in the room is recycled through a
canopy over the operating table and passes through a 5µm filter.

• Filtration -
Filter all air with prefilter followed by final filter (two – stage filtering). Air is drawn
in from the atmosphere and passes through a 5µm filter to 95 percent
efficiency coarse filter to remove dust and debris is installed after the atmosphere
air has been drawn into the air handling unit (AHU).
- Before the air is delivered to the operating site it passes through a high efficiency
particulate air (HEPA) filter with a 0.3µm filter and a 99.97% efficiency which
removes bacterial contamination.
- The air is introduced at the ceiling and exhausted near the floor.
- Exhaust system in the corridors and the sluice room then removes the air to the
atmosphere outside. Regular service and maintenance of the ventilation plant is
essential, the filter should be changed at least twice per year or more as determined
by the atmospheric conditions eg high dust or pollution.

• Flow
- There should not be reversal of air flows when exits are opened nor any leakage
through the seals around the doors and windows when they are closed.

• Pressure -
Differential pressure shall be a minimum of 2.5 Pa between different areas in the OT to
ensure air flow as recommended in Table 3..

16
Machine Translated by Google

Table (3): Recommended specifications of Air Supply in different areas of the OT.
Minimum
Air Re-
air Minimum All air
movement circulated Relative
Area change of total air exhausted Design
relationship outdoor to by means humidity %
designation change of room temperature
to adjacent outdoors
area. area
air per per hour units
hour
Operating
rooms/ - 20-23C
Out 3 20 No 50-65
delivery 68-73F
room. room

Recovery - - 21-24C
2 twelfth No 50-65
room. room 70-75F
Critical
and - - 21-24C
2 twelfth No 50-65
intensive 70-75F
care. care

Anesthesia
Gas Print - 15 Yes No - -

storage
Janitor - - -
Print ten Yes No
room. room

Bathroom - - - - 24C
Print ten
75F
Clean linen - - - - -
Out 2
storage
Dirty
corridor/ Print - ten Yes No - -

dirty room

If any maintenance activities involving the air supply system in the operating theater, the infection control department
should be informed and any work in the theater area should only resume with the permission of infection control
department after the collection of the appropriate environmental samples.

17
Machine Translated by Google

• Temperature and humidity:

- Temperature and humidity control is essential with an air conditioning unit attached to
a monitoring system to carefully regulate both temperature and humidity.

- It is preferred to have a system with the facility to print out and record the
parameters in the sterile core.
- Special air conditioning and voltage regulation shall be provided.
- Temperature shall be maintained between 20-23 degree centigrade (68-73 F) in
the operating room with relative humidity should have a minimum 50% - 65% with 55% being
the average recommended . The higher the humidity the higher the chance of an
electronic sparks developing.
- Humidifiers shall not permit the growth and multiplication of microorganisms.
The operating room should be 1°C cooler then the outer area

Scavenging system:

- A scavenging system captures and exhausts waste gases to minimize the exposure of the
operating room staff to harmful anesthetic agents. Scavenging systems remove gas by a vacuum
or a passive exhaust system or both. Vacuum scavengers use the suction from an operating
room vacuum wall outlet or a dedicated vacuum system. To prevent positive or negative pressure
in the vacuum system from affecting the pressure in the patient circuits, manifold-type vacuum
scavengers use one or more positive or negative pressure relief valves in an interface with the
anesthesia system. In contrast, open – type vacuum scavengers have vacuum ports that are
open to the atmosphere through some type of reservoir; Such units do not require valves for
pressure relief. Passive exhaust scavengers can vent into a hospital ventilation system (if
the system is the non-re-circulating type) or, preferably, into a dedicated exhaust system.
The slight pressure of the waste gas discharge from the anesthesia machine forces gas
through large-bore tubing and into the disposal system or directly into the atmosphere.

- The NIOSH (National Institute of Occupational Safety and Health) recommended

exposure limit (REL) for N2O is 25 ppm as a time-weighted average (TWA) during the period
of anesthetic administration .This REL is intended to prevent reduction in mental performance,
audiovisual ability, and manual dexterity during exposures to N2O.

- N2O should be monitored when the anesthetic equipment is installed and every 3 months
thereafter
- Connection ports with different-diameter hoses for N2O and O2 should be used
reduce the possibility of incorrectly connecting the gas delivery and scavenging hoses.
- All rubber hoses, connections, tubing, and breathing bags should be checked daily and
replaced when damaged or when recommended by the manufacturer
- The scavenging system exhaust rates (flow rates) shall be approximately 50 liters per
minute (L/min) to minimize leakage of N2O.

18
Machine Translated by Google

Gas and suction system:

- Gas and suction outlets should be self sealed when not in use
- Outlets from different gases should have non interchangeable connections , for fear of
giving wrong gas during anesthesia
- Filters on air and gas supplies should be capable of removing all particles larger than 5
microns
- Standardizing the position of gas outlets throughout the hospital to ensure that
accident cannot occur so outlets should supply oxygen, air, suction and nitrous oxide
provided in that order from left to right
- Portable anesthesia machine should provide 1 oxygen, 1 air, 1 suction and one nitrous
oxide gas outlet in the anesthetic room
- There must be 3 suction outlets per room for operative rooms and 3 outlets per bed in
recovery room

Water supply:

- Hot and cold water supply at sufficient pressure should be piped to most areas of
theater to operate all fixtures and equipments during maximum demand
- Hot water should be at maximum temp 65 degree centigrade
- Supply capacity for hot and cold water piping should be determined on the basis of fixture
units using recognized engineering standards branch
- Each water service main , main riser and, branch to a group of fixtures ,should have valves
and stop valves should provide for each fixture and appropriate panel for access should
be provided at all valves where required
- Filtered water may be provided for drinking
- Drainage system for water sinks should be adequate and efficient
- General piping requirements: from inner material, clean joining, no erosions, not
enhancing microorganism growth, smooth with no cracks or crevices , nonporous, and
have no dead legs (should have continued flow)
- Common piping materials:
1- stainless steel
2- aluminum
3- PVC or CPVC

19
Machine Translated by Google

Drainage system:

- Drainage piping shall not be installed within the ceiling or exposed in operating, delivery
rooms, central services, and electronic data processing area.
- Floor drains are not to be installed in operating and delivery rooms.

Communication:

- Telephones can be positioned in anesthesia or laying up room and telephone should be

silent and have light indicator for urgent messages
- Ringing phones or telecom are permitted in offices, rest area, reception area, nurse station at
recovery bay
- Telecom can be installed for communication between operating theater and laboratory, reception
and other rooms

Electricity:

- Service pendants for electricity may be used for plugging in the anesthetic machine, monitoring
equipment or to provide power for the diathermy.
- It is much safer for wiring to be plugged in at a height, to prevent personnel tripping over the
wires and disconnecting vital equipment.
- All electrical points shall be capable of giving sufficient power for many varieties of
machinery.
- Transformers shall be provided to protect the delicate machinery from sudden surges
of power.
- All electrical points in the operating theater suite shall be serviced by the emergency power
system. There shall be no more than 10 second transfer of power supply.

20
Machine Translated by Google

Safety requirements

Fire Alarm:

- A single state fire alarm system shall be provided throughout the building.
- The fire alarm system shall be designed and installed in accordance with the
requirements of National Fire Standard -
Heat detectors shall be installed in the following areas: I. Storage
rooms, II. Mechanical
equipment and service rooms, III. Janitor closets.

- Smoke detectors shall be installed in corridors, at top of each exit stair shaft, in every
holding room
- Smoke alarms shall be installed with permanent connections to an electrical circuit and shall have
no disconnect switches between the over-current device and the smoke alarm.

- It is not recommended to have water sprinklers in the theater suite itself. Automatic heat
sensing devices may be used, but in low occupancy areas such as stores, smoke detectors
should be installed.
- Fire alarm signals shall be audible only at the reception desks and offices. Fire panels in the other
areas shall have flashing lights and the location of the fire on the panel.
- If electromagnetic doors are used in the theater suite, then there must be an automatic
release for manual door opening.

Portable Fire Extinguishers:

- Multi-purpose fire extinguishers 5 Kg or equivalent capacity shall be provided and so located that
the travel distance to an extinguisher does not exceed 15 m.
- Fire extinguishers shall be located so that they are not unduly exposed to fire hazards and where
possible, at or near the exits from the building or room, and shall be mounted by means
of wall attachments.
- Fire extinguishers shall be installed in accordance with the requirements of the National
Fire Standards.

21
Machine Translated by Google

Emergency lighting:

- Power for emergency lighting systems shall be provided from either :

I. A generator, “Emergency Electrical Power Supply for Buildings or II.
Batteries “Unit Equipment for Emergency Lighting.”.
- The emergency lighting shall be provided to average levels of at least 10 lx at floor
level in exits, corridors, principal routes providing access to exits, generator rooms,
holding rooms, and traditional healing rooms.
- The emergency lighting system shall be provided to continuously supply power in the
event that the regular power supply is interrupted and be so designed and
installed that upon failure of the regular power it will assume the electrical load
automatically for a period of not less than one hour.

Exit signs:

- Must have an illuminated sign with 'EXIT' above the door.

- Fire exits are located at the end of the main corridor leading to the outside.
- A continuous illuminated exit sign shall be provided in means of way out, over every exit
door and over every way out from rooms with an occupant load greater than 30.

Emergency exit doors:

- As any other facility, emergency exit doors should be available in the operation theater
for any possible emergency evacuation. However, during non-emergency situations,
these doors must remain closed at all times. These doors are directly connected to
the outside so they are in the dirty or outer zone.
- No emergency doors should be located near the sterile operating theater.
- All exit doors shall open in the direction of exit travel.
- Exit doors shall be clearly identifiable and no hangings or draperies shall be placed
over emergency exit doors to conceal or obscure any exit.

22
Machine Translated by Google

References:

- Guidelines for design and construction of hospitals &health care facilities.

AIA (American Institute of academy of Architects), the facility guidelines institute, with
assistance from US department of health and human services, 3rd edition Aug.
2002
- Standard specification for design of operating theaters and Intensive Care Unit.
Directorate of Infection Control, Ministry of Health, Kuwait 2001.
- Fire safety requirements for health stations, health centers and nursing stations.
Technical Committee of Health Care Facilities, Government of Canada Sep.1999 (last
modified Sep. 2003). Available from www.hrsdc.gc.ca/asp/gateway.asp
- Effective energy-efficient lighting for healthcare, Small commercial lighting program in New York
State. Available from http://sclp.lightingresearch.or/healthcareresources.asp
- Controlling exposures to nitrous oxide during anesthesia administration, Anesthetic gases
guidelines for work place exposures. NIOSH (National Institute of Safety and Occupational
Health, USA) May, 2000.
- Plumbing design for health care facilities ,American Society of Plumbing Engineers, ASPE
Plumbing engineering Design Hand book, volume 3. Available from
www.ASPE.org/ASPE_publications
- Anesthesia gas scavenging system, Article by Carl Lawes , Available from
www.ebme.co.uk.
- Introduction to scavenging, Anesthesia UK (An educational site with training
resources for Anesthetic professionals) www.frca.co.uk
- Hospital Infection Control setting up with minimal resources, Shaheen Mehtar, Oxford
University Press, 1992.
- General Principles of OR Design and Construction, ACS Surgery: Principles and Practice.
Available from www.medscape.com\viewarticle\503005_2

23